A nurse-led, needs-based psycho-education intervention for Chinese patients with first-onset mental illness
To shorten the waiting time for psychiatric treatment, nurse-led services may help in the first-line mental health consultation and interventions for patients with recent first onset of mental illness.
The study evaluated the effectiveness of a six-session nurse-led, needs-based psycho-education program for Chinese patients with mental health problems newly referred to an outpatient clinic in Hong Kong, when compared with routine outpatient care.
A randomized controlled trial with a pre- and post-test, control group design was conducted. Seventy-nine patients were randomly assigned to either the nurse-led psycho-education program (N = 39), or to usual psychiatric outpatient care (N = 40). Multiple patient outcomes and services utilization were measured at recruitment and 2 weeks after the intervention.
The results of a multivariate analysis of variance test indicated that the psycho-education group had significantly greater improvements in mental and overall health status, insights into their treatment and illness, and hospitalization rates at the post-test. Implications: The findings provide evidence that nurse-led, needs-based psycho-education can improve mental health, self-efficacy and insights into mental illness in Chinese first-onset mentally ill patients. A future multi-center controlled trial of this nurse-led intervention is recommended.
Available from: Daniel Bressington
- "To address these gaps in services and provide as early intervention as possible, nurse-led mental health services could be a useful alternative approach when specialist EIS provided by larger multi-disciplinary mental health care teams are not available. However, there is still relatively scant evidence about the efficacy of approaches in the care of people newly referred to psychiatric services with an acute episode of first-onset mental illness (Haddock and Lewis, 2005; Bertelsen et al., 2008; Chien et al., 2012). One of the few studies on a nurse-led self-harm assessment and treatment program in the United Kingdom indicated that the service was potentially cost-effective and resulted in a significant reduction of self-harm behaviors and physical injuries (Griffiths et al., 2001). "
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ABSTRACT: This study aimed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness. A single-blind, parallel group, randomized controlled trial design was used. The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong. Patients were randomly assigned to either an eight-session nurse-led psychosocial intervention program (plus usual care) or usual psychiatric outpatient care (both n=90). The primary outcome was psychiatric symptoms. Outcomes were measured at recruitment, one week and 12 months post-intervention. Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual. There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up. The findings provide evidence that the nurse-led psychosocial intervention program resulted in improved health outcomes in Chinese patients with first-onset mental illness.
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Available from: Marsha, M., ML. Lynn Campbell-Yeo
- "Most studies used reliable and valid outcome measures to evaluate patient-important outcomes such as health status, quality of life, and satisfaction with care which strengthens the generalizability of the findings; however, some studies had very short-term follow-up periods (e.g., two weeks after the patient appointment) which may compromise generalizability of study findings over the long term [39, 48, 60]. "
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ABSTRACT: Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (), NP-transition (), NP-inpatient (), CNS-outpatient (), CNS-transition (), and CNS-inpatient (). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
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